Right picture: The indigenous patient has a coeliac disease which is a gluten-sensitive enteropathy, and is not operative.
Left picture: Here, a Hirschsprung´s disease is present which was diagnosed late. Because today most patients with congenital megacolon are recognized in Europe in the neonatal period or in infancy except for ultrashort types, in toddlers and schoolchildren with large belly and constipation the differential diagnosis of Hirschsprung´s disease is often not considered; in schoolchildren with Hirschsprung´s disease malnutrition is even better recognizable.

The most striking sign of both toddlers is a large, distended abdomen.
Left picture: The origin of this child is Lybia; the child has been suffering from constipation since infancy.
Right picture: This Swiss child has voluminous and thin stools.